12.10 elicker radiology - ucsf cmepneumothorax. 10/13/2016 15 checklist lines, tubes and foreign...
TRANSCRIPT
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Chest Radiology Checklist: Tips,
Tricks and Things You Should Never
Miss!
Case #1
Checklist
Lines, tubes and foreign bodies
Endotracheal tubes
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Airwaylandmarks
3-7 cm
What is the ideal location?
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Tip position with changes in head
Esophageal intubation Esophageal intubation
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Enteric tubes
When is the tube post-pyloric?
GE junction
2nd duodenum
3rd duodenum
4th duodenum
Ligament of Treitz1st duodenum
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Tension PTX s/p feeding tube removal
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Central lines
AzV
SCV SCV
IJ IJ
RBCVLBCVSVC
Venous anatomy
The Elusive Cavoatrial Junction Venous landmarks
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Variation with expiration ? location
Right posterior oblique
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AzV
SCV SCV
IJ IJ
RBCVLBCVSVC
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Left SVC
Duplicated SVC Duplicated SVC
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Pacemaker in left SVC PICC in internal mammary vein
RIJ line in aorta PICC line in aorta
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Arterial line Venous line
Central line free in mediastinum
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Pulmonary artery catheters
Infarct from a PA line Pulmonary artery pseudoaneurysm
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Retained surgical sponge Retained catheter fragment
Checklist
Lines, tubes and foreign bodies
Pneumothorax
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Checklist
Lines, tubes and foreign bodies
Pneumothorax
Pneumothorax vs. skin fold
• Pleural line, NOT edge
• No vessels lateral to line
• Line doesn’t go outside chest wall or across
midline
Pleural Line
Air inpleura
Edge
Air inlung
Pleural Line
Air inpleura
Edge
Air inlung
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Skin fold
Where is the PTX?
Not a PTX!
Pre‐IJ line removal Post‐IJ line removal
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Deep Sulcus Sign ARDS with pneumothorax
Pneumothorax (subpulmonic) ? PTX
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Tension pneumothorax
Checklist
Lines, tubes and foreign bodies
Pneumothorax
Case #3
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Checklist
Lines, tubes and foreign bodies
Pneumothorax
Mediastinal abnormalities
Normal mediastinal interfaces
Rightparatracheal
stripe
Aorta
Leftpulmonary
artery
Aorticopulmonary window
Azygoesophagealrecess
Tuberculosis
Metastatic disease (unknown primary)
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Lung Cancer Esophageal cancer
Checklist
Lines, tubes and foreign bodies
Pneumothorax
Mediastinal abnormalities
Case #4
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Checklist
Lines, tubes and foreign bodies
Pneumothorax
Mediastinal abnormalities
Tough spots in the lungs
Subtle cancer #1
Subtle cancer #2 Subtle cancer #3
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? pneumonia ? pneumonia
Normal LLL Pneumonia Normal Pleural effusion
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Normal Nodule Normal Pott’s disease
Checklist
Lines, tubes and foreign bodies
Pneumothorax
Mediastinal abnormalities
Tough spots in the lungs
Don’t forget about the bones
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Checklist
Lines, tubes and foreign bodies
Pneumothorax
Mediastinal lymphadenopathy
Lung nodules
Bones
A simple approach to lung opacities…
Alveolar Interstitial
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Airways Not applicable
Alveolar
• Features of alveolar disease
– 1. Confluent opacities
– 2. Air bronchograms
– 3. Fluffy at the periphery
What producesalveolar opacities?
• Fluid
• Blood
• Pus
• Cells
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ARDS
Pulmonary edema
PCP Pneumonia
Hemorrhage
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Which compartment of lung is affected Interstitial
Interstitial Alveolar Miliary TB
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What diseases cause small nodules?
• Infections (fungus and tuberculosis)
• Malignancy
• Sarcoidosis
Miliary TB
Miliary fungal
Sarcoidosis
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Metastatses: lung cancer
Interstitial
What diseases cause lines?
• Pulmonary edema
• Malignancy
• Interstitial lung disease (e.g. IPF)
Pulmonary edema
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Edema Idiopathic pulmonary fibrosis
Which compartment of lung is affected?
Airways disease
• Circular
• Tubular
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Cystic fibrosis